Riverside Medical Center leadership:

Transcription

1 1 TL2 How nurses at every level CNO, nurse administrators, and direct-care nurses- advocate for resources, including fiscal and technology resources, to support unit/division goals. The Riverside Medical Center leadership is defined as the board of directors, administrative staff and physicians in appointed or designated leadership positions. Riverside Medical Center leadership is responsible for providing a framework for planning health care services provided by the organization based on the organization s mission. Leadership is also responsible for developing and implementing an effective planning process that includes a collaborative assessment of our customer and community needs, a long range strategic plan, operational plans, monitoring compliance with annual operating budget, annual capital budgets, monitoring and establishing resource allocation and policies, and ongoing evaluation of the plans. The planning process addresses both patient care functions (access, treatment, patient rights, patient teaching, discharge planning and assessment) and organizational support functions (information systems, infection control, safety, environment and performance assessment and improvement). Riverside Medical Center leadership: Is responsible for collaborating with community leaders, organizations, staff and patients to design services to be provided by the organization that are appropriate to the scope and level of care required by the patients we serve. Communicates the organization s mission, goals, objectives and strategic plans. Approves the Quality Improvement Plan that is designed to prioritize areas for improvement and re-prioritize in response to unanticipated events. Gather, assess, and act on information regarding patient and family satisfaction with the services provided. Provides a uniform performance of patient care processes throughout the organization. Develop programs for recruitment, retention, development and continuing education of all staff members. Consider clinical practice guidelines when designing or improving new processes. Provides appropriate direction, management and leadership of services and/or departments. Provides staffing resources appropriate to meet the needs of the patients served. Establishes systems which promote the integration of services for the patients continuum of are needs. Appoints appropriate committees, task forces, and other forums for interdisciplinary collaboration on issues of mutual concern. Involves department heads and direct care staff in evaluating, planning and recommending annual expense and capital objectives, and expense budgets based on the expected resource needs of their departments. Department heads are held accountable for managing and justifying their budgets and resource utilization.

2 2 This includes, but is not limited to identifying, investigating and budgeting for new technologies which can be expected to improve the delivery of patient care and services. Annual Review Process of Budget and Plan for Services The nursing staff at Riverside Medical Center has many opportunities to advocate for resources during the budget process and ongoing throughout the fiscal year. All nurses, from the COO/CNO to the direct care nurse at Riverside are very active in both the capital and operational budget process to support unit/division goals. Riverside Medical Center has a fiscal year that begins in January of each year. Early July of each year is when the entire budget process for the following year begins. The budgeting process can be viewed in three distinct parts: 1. Calculations of global assumptions, 2. Creation of the management plan, and 3. Construction of the operational and capital budgets. It is important to Riverside Medical Center that the nursing staff, from the direct care nurse to the COO/CNO all be involved in these three processes to advocate for resources including starting new services for patients. As shown in the below from Dave Duda, Sr. VP/COO/CNO, the process of expanding current programs, starting new programs, capital needs of $75,000 or greater starts with a presentation to Senior Management in the summer/fall of each fiscal year. Dave Duda from 5/13/2010 re: budget process It is with this comprehensive approach involving staff at all levels that supports Riverside Medical Center s success. It is important to describe the budget process at RMC to fully understand the ability of the direct care nurses at RMC to advocate for resources. The First Step: Collaboratively Calculating Global Assumptions The first step in the budget process, the calculation of global assumptions (patient volume forecasts), begins with the holding of several meetings with the Nursing Directors, Managers, and Team Leaders to discuss service line volume projections. This meeting includes discussion of both current and new service line growth.

3 3 Meetings are conducted in the Board Room with all parties present. At this time, the Directors, Nurse Managers, and Team Leaders communicate direct care nurse ideas and suggestions for technology and patient care needs for both the capital and operating budgets to the Vice President (VP) of Nursing and Senior VP-COO/CNO. The COO/CNO and VP of Nursing, as a part of the senior management team, have direct access to the medical staff and also discuss medical staff s service line suggestions that may impact the delivery of nursing care. The meetings have a strategic focus. Both ideas and challenges are presented in respect to patient volume forecasts. The retirement of a physician or the addition of a new physician will require adjustments in the delivery of patient care. Distributions of patient volumes to nursing units are also discussed. Unit staffing needs are discussed as well as a need for education and training expenses or capital equipment to support volumes. The need for resource support staff like social work, physical rehabilitation, and the like are also evaluated. Representatives from these support areas are also present at the meeting to allow for collaboration in advocating for resources across the interdisciplinary care team. We believe a collaborative effort with support staff strengthens our ability to meet resource needs by understanding the goals nursing is proposing. While this meeting is organized by the Financial Services division, it certainly is directed with the sole intention of meeting the goals of the department of nursing. This opportunity to have a captive audience with the Chief Financial Officer, the Corporate Director of Finance and the COO/CNO, gives the COO/CNO and VP of Nursing a competitive advantage to achieve resource allocations. Approximately two to three meetings are required to complete the formulation of patient volume projections which will drive the entire organizational budgeting process. These assumptions are at a high level during this part of the budget process. Some information from this meeting is used by the leadership team to create the goals within the management plan for each department/division (also referred to as part of the overarching organizational strategic plan). The Second Step: Creation of the Nursing Management Plan and Goals to Support Budget Requests The VP of Nursing, under the direction of the COO/CNO, assembles the nursing management team to elicit information for the creation of the nursing division strategic plan. This leadership team brings forth initiatives that the direct care nurses and management team would like to evaluate. The COO/CNO and VP of Nursing brings forth their own initiatives they believe would be productive for the division. Through several meetings, a strategic plan is formulated. The creation of this plan allows the COO/CNO and VP of Nursing to be prepared for what resources are needed in the budget to execute the initiatives. This plan then moves forward to the next step in the annual budget process.

4 4 The second step, the organizational management plan is then reviewed by the senior executive team at a one day retreat. Vice Presidents from all areas of the organization attend the meeting and present their division s proposed management plans. This process allows the COO/CNO and VP of Nursing to evaluate nursing needs to support goals requested by other departments that might have been missed earlier in the process. In the past 3 years, several nursing directors have been invited to participate in the creation of the organizational management plan during this retreat. Riverside believes this process allows the organization to remain in touch with the spectrum of nursing. It also begins to provide succession planning for future executive roles at Riverside. It is at this meeting that the COO/CNO and VP of Nursing begin to advocate for support of unit/division goals. The VP of Nursing presents their plan to the senior team with a focus on patient and community needs, quality outcomes, human resource and capital equipment needs to accomplish the unit/division goals. The conclusion of this meeting defines the approved organizational goals, including the division of nursing. This management plan is therefore utilized to guide resource distribution in the operational and capital budgeting process for the next year. The Third Step: Creating the Capital and Operational Budget The management plan drives both the operational and capital budgets but not all resources are defined within the management plan. Fiscal resource needs that are not addressed by the management plan are formulated at the unit manager level with collaboration with the nursing director. The global assumption (patient volume forecasts) discussed earlier, are released by the finance department via an electronic budgeting software program called SRC. SRC is used to request operational resources in the budget process. Managers and directors enter resource dollar projections into the system for labor, supplies, and travel and conference meeting dollar requests are also entered. Through nursing leaders rounding during the course of the year and asking for staff input on tools/equipment and ideas to improve the care environment, direct care nurses suggestions are captured on an ongoing basis and evaluated for inclusion into the management plan and the budgeting process. Also considered in planning the budget are the following items: 1. Patient requirements for care and effectiveness of the plan for staffing. 2. Existing and proposed patient care programs offered and/or patient populations that were added or eliminated and resultant changes in case mix. 3. A retrospective analysis of actual staffing patterns and variances in meeting patient needs for care with special attention to patterns or trends. 4. Findings from staff input, quality improvement, patient safety, utilization review, productivity studies, and other hospital-wide activities such as customer satisfaction surveys and physician surveys.

5 5 5. Previous years statistical data and projected future growth or new program development. Each unit s budget is then rolled up into a divisional operating budget. The Vice President of Nursing then meets with the COO/CNO and the Chief Financial Officer to refine the operating budget. It is at this time that the VP of Nursing again has an opportunity to advocate for the proposed resources. Clarification in the unit/division needs and goals is given to the Chief Operating Officer and Chief Financial Officer if needed. Upon completion of the Vice President meetings with the COO/CNO and Chief Financial Officer, the budget is completed and distributed to the Board of Directors for final approval. The capital budget requisition is also completed via an electronic request. The software system for this process is called StrataCap. During this process, direct care nurses make requests to the team leader, unit manager, and director for medical equipment, information technology, or facility changes that costs in excess of $1, The requests are then divided into pools and meeting invitations are sent to the directors. Anyone may attend the budget meetings if requested. The COO/CNO, VP of Nursing or designee attends all budget pool meetings. The pools are defined as facility construction, durable medical equipment, and information technology. Each has subclasses that are defined by dollar ranges for that class. The Chief Financial Officer allocates a total dollar amount that may be awarded based upon volume projections for each pool, previous year s history, current requests submitted, and the approved management plan goals. All departments leaders that requested capital in that pool are invited to a meeting to complete the capital budget cycle. The directors in attendance negotiate the requested capital to meet the budgeted monies based upon priority of needs by the group. This process reduces duplication of unnecessary purchases, educates individuals of new technologies and promotes sharing of internal resources and collaboration. Pooling Resources Across the Nursing Division Bladder Scanning For example, in 2009, several nursing units requested the purchase of a bladder scanning device for the measurement of urinary residual. The pool group decided to purchase one device and share it amongst the floors leaving other fiscal resources to be utilized for other purchases in the budget. The group created a strategic plan to purchase two other devices in the following year budget; which was approved in the 2010 budget. It is this comprehensive strategic planning that makes Riverside Medical Center nurses advocates to support unit/division goals and fosters a spirit of collaboration across all units. Five Year Plan to Replace Unit Defibrillators with Biphasic Units Accomplished! The COO/CNO and VP of Nursing also work closely with the Biomedical Department in the capital budget process. The updating, replacement and additional purchase of

6 6 general medical equipment is substantial. For example, the VP of Nursing worked with the Director of the Biomedical Department to replace unit defibrillators to all biphasic units. The plan required a five year plan to complete the process. Biphasic units are proven to have a higher rate of successful conversion to a normal heart rhythm with the least amount of myocardial damage [Source: The last of the biphasic defibrillators will be purchased in the 2010 budget. This initiative was the direct result of research that concluded a higher quality outcome would be achieved with this equipment. The VP of Nursing therefore created the vision to strategically plan for the purchase over a multi-year budgeting process to accomplish this goal. Communicating the Final Budget Both the operational and capital budgets are disseminated to the VP of Nursing, directors, and managers upon approval from the Board of Directors. In return, direct care nurses are informed of the approved budgets including adjustment to staffing ratios and approved capital equipment. Information regarding the budget takes several forms - from unit meetings to memos to direct conversation with employees. Planning for the Unexpected: Perioperative Services Request for Patients Wellbeing Unanticipated operational events occur during the budget year. The operational resources (including human resources) needs of the nursing division are addressed by the VP of Nursing to the COO/CNO and Chief Financial Officer (CFO) or with a formal presentation to the Senior Leadership team at the Chief Executive Officer s (CEO s) request. Each Wednesday of the week the Chief Executive Officer conducts a senior management team meeting. It is at this meeting that Vice Presidents present newly formed strategic initiatives. It is not uncommon Nursing Directors attend the senior management meeting to present unanticipated operational needs in conjunction with the COO/CNO and VP of Nursing. Like the budget process, the requests are evaluated and decisions are rendered based on operational capacity. Major operational and capital requests for the proceeding budget year are encouraged to be presented in this forum prior to the budget process. This forum allows other divisions to formulate necessary support for the goal in a timely manner. In one such case, the Director of Perioperative Services presented an unbudgeted capital item to the senior management team. The request was for a new type of leg holder for patients that are undergoing a total hip joint replacement. The leg holder positioned the leg in a different manner due to the anterior approach for the surgery as compared to the standard posterior/lateral approach. The new approach by the surgeon eliminated the cutting of muscle tissue by allowing the surgeon to separate the muscle instead. The outcome for the patient was a hospital stay of approximately 1.5 days compared to the typical previous three days. Pain was dramatically reduced due to the muscle sparing approach too. The request was approved due to the Director s ability to advocate the benefits of the new approach for the patients wellbeing.

7 7 All Levels of Staff Have a Voice in the Budget Process As described in this SOE, nurses at all levels of the organization have the ability to advocate for resources to achieve unit/division goals. Riverside has the structure and process in place and the empowered staff to assure the direct care nurses providing have a voice.